Insurers Face A Screen Test

Michael Moore Film Stirs Resentment Against U.s. Health Care System

If filmmaker Michael Moore had his way, Aetna, CIGNA, and other health insurance companies across the nation would be dead meat -- replaced by a government-run system.

It's not clear yet how much of a threat his new documentary, ``Sicko,'' is to the industry. But with its general release currently set for June 29, the film's previews and advance promotions are reigniting the resentment against insurers that tends to simmer between boiling points.

Local companies don't fare as badly as some in the movie, which revels in tales of patient-dumping and death-hastening denials by other insurers.

The film slaps CIGNA for approving one hearing implant instead of two for a toddler, and Aetna gets off with just a flash of its corporate logo sign. Moore has said Aetna insures his employees.

The film goes relatively easy on the local companies, but Moore doesn't play favorites. He takes direct aim at the U.S. health care system and the whole insurance industry, which employs thousands of people in the Hartford-Middletown region.

Rather than pick on individual companies, the veteran rabble-rouser urged a rally last week in Sacramento to wage ``a war against health insurance companies, who are more interested in lining their pockets than caring for the people of the United States of America.''

``We have to get rid of them once and for all,'' he said. The receptive crowd, which included nurses, picked up his next line as a chant: ``It's time for them to go.''

Insurers say they're not worried sick about ``Sicko,'' despite the popularity of Moore's previous films such as ``Fahrenheit 9/11'' and ``Bowling for Columbine.''

``I think it's very, very clear the American people don't support a government takeover of the health care arena,'' Karen Ignagni, the trade group's president and chief executive, said in an interview Tuesday. She warned of rationing and long waits for care in other countries with single-payer systems.

She said insurers view ``Sicko'' as an opportunity to discuss their proposals to get more people insured through public-private partnerships, and ``talk about the value we provide'' through disease prevention and management, and other programs.

As for Moore, ``Essentially what he's done is filmed an editorial,'' Ignagni said. ``There was never any attempt by Mr. Moore to seek out our members to answer questions, to respond to cases in the movie.''

Publicists for Moore said he was too busy to be interviewed for this story.

Some of the patient cases Moore used are more than 10 years old, Ignagni said.

CIGNA, whose health insurance operations are based in Bloomfield, wouldn't talk about details of its own case in ``Sicko.'' But the company did discuss the general subject -- cochlear implants, which are complex electronic, surgically implanted devices that provide a sense of sound for deaf people.

The movie shows parents who were shocked that CIGNA initially approved coverage for only one cochlear implant instead of two for their deaf daughter. The toddler's father says in the film that CIGNA apparently felt it was ``experimental to hear in two ears.''

The father calls CIGNA to say Moore has taken an interest in the case and asks, ``Has your CEO ever been in a film before?'' The film shows CIGNA's Philadelphia headquarters and replays a taped phone call from a company representative, cheerfully reporting the denial was reversed and two implants would be covered.

Only about 3 percent of 100,000 people worldwide who have cochlear implants have two, according to the University of Wisconsin Waisman Center. Medicaid and some private insurers will cover only one. Insurers cite the risks and until recently, a shortage of evidence showing the benefits of doing two implants.

One risk noted by the U.S. Food and Drug Administration is bacterial meningitis, a serious and sometimes fatal infection. Also, some doctors recommend against implants in both ears because it precludes trying new, better technology that might be developed.

CIGNA's policy was to cover only one implant, figuring two would double the meningitis risk, said Dr. Jeffrey L. Kang, the company's chief medical officer. Besides, there was little evidence of improved hearing from bilateral implants until a couple of recent studies found they helped deaf people determine where sounds were coming from, he said.

Based on the new evidence, CIGNA changed its policy in March to cover two implants without requiring prior approval. Kang said the change didn't stem from Moore's film.

A single implant can cost $50,000, but Kang said, ``Our [decision] process is a scientific, clinical one which is devoid of any considerations of cost.'' The doctors at CIGNA who are involved in the process aren't given financial incentives to base decisions on cost of medical procedures, he added.